Introduction
The use of placebo and the consequent placebo effect in medical practice have elicited a mixture of reactions for many years. For instance, there are those medical practitioners who argue that it is a significant practice which has brought immense health benefits such as improved patient recovery process, emotional and physical well being of patients.
On the other hand, there are those who have vehemently opposed the use of placebo arguing that it is a morally questionable and outdated practice whose mechanism is unknown and that implies paternalism and massive deceit.
Nonetheless, studies in pain medicine indicate that placebo effect is an effective and special alternative medicine that allows patients to develop positive attitude towards the process of recovery even after being given a treatment which has no therapeutic value.
Barnhill (2011) posits that the mechanisms of placebo is largely concerned with making use of a patient’s psychosocial context and psychological aspect when administering drugs to relieve depression and pain. This paper examines placebo effect, related theories as well as its implications in medical practice.
Placebo theories and mechanisms
Response expectant theory
In medicine, the improvement of patients’ health through placebo is a factor that has been attributed to patients developing expectations that whatever has been given to them to ease pain is effective and can produce better results (Carpenter, 2009).
On a global scale, studies on the application of placebo indicate that the mechanisms for using placebo in medicine have been meant to create a therapeutic relationship, build positive emotions, offer hope and faith to patients and reduce anxiety.
Irving Kirsch argues in his response expectant theory that even without an active treatment, developing a belief by patients that the treatment is real can bring about a recovery process.
Doctors enhance the expectancy effect of a patient through factors like injections, placebo pills of different colors and sizes, and enthusiasm. The latter works effectively when doctors show confidence, attention and warmth to patients.
Conditioning and expectation
Placebo effect works effectively on the mechanisms of expectation and conditioning (Barnhill, 2011). Therefore, it will work differently depending on what the placebo being used has been described. For instance, a placebo administered as a stimulant will take care of blood pressure and heart rhythm. However, its effects will change if the placebo has been given as depressant. The reason for this is because the bases of placebos rest on expectations and perceptions of affected patients.
Negative effects
Inert substances given out as placebos may have negative effects commonly known as nocebo effects, and which occur in form of worsened symptoms and death (Bennedeti, Carlino & Pollo, 2011). Besides, administering placebo to treat pain may eventually cause patients to develop side effects. For instance, a patient given opiate as a placebo to relieve pain may ultimately develop respiratory depression. In addition, placebo treatment can cause withdrawal symptoms among patients.
References
Antonaci, F., Chimento, P., Sances, G. & Bono, G. (2007). Lessons from placebo effects in migraine treatment. The Journal of Headache and Pain, 8(1), 63-66.
Barnhill, A. (2011). What it takes to defend deceptive placebo use. Kennedy Institute of Ethics Journal, 21(3), 219-50.
Bennedeti, F, Carlino, E. & Pollo, A. (2011). How placebos change the patient’s brain. Neuropsychopharmacology Reviews, 36, 339–354
Carpenter, W. T. (2009). Placebo effect in depression. The American Journal of Psychiatry, 166(8), 935-935.
Finniss, D. G., Kaptchuk, T. J., Miller, F., & Benedetti, F. (2010). Biological, clinical, and ethical advances of placebo effects. The Lancet, 375(9715), 686-95.